Document Detail

Thrombosis and hemorrhage in the acute period following Gamma Knife surgery for arteriovenous malformation. Case report.
MedLine Citation:
PMID:  19249934     Owner:  NLM     Status:  MEDLINE    
Bleeding of an arteriovenous malformation (AVM) following stereotactic radiosurgery (SRS) is a known risk during the latency interval, but hemorrhage in the 30-day period following radiosurgery rarely has been reported in the literature. The authors present the case of a 57-year-old man who underwent Gamma Knife surgery for a large AVM, and they provide radiographic documentation of a thrombus in the primary draining vein immediately preceding an AVM hemorrhage within 9 days after radiosurgery. They postulate that the pathophysiology of an AVM hemorrhage in the acute period following SRS is related to an association among tissue irradiation, acute inflammatory response, and vessel thrombosis. The authors also review the literature on risk factors for hemorrhage due to untreated and radiosurgically treated AVMs. Recent evidence on the role of inflammation in the pathogenesis of AVMs and the pathophysiology of AVM rupture is presented. Inflammatory markers have been demonstrated in brain AVM tissue, and the association between inflammation and AVM hemorrhage has been established. There is an acute inflammatory response following tissue irradiation, resulting in structural and functional vascular changes that can lead to vessel thrombosis. Early hemorrhage following radiosurgical treatment of AVMs may be related to the acute inflammatory response and associated vascular changes that occur in irradiated tissue. In the first stage of a planned 2-stage Gamma Knife treatment for a large AVM in the featured case, the superior posteromedial portion of the primary draining vein was included in the treatment field. The authors present the planning images and subsequent CT scans demonstrating a new venous thrombus in the primary draining vein. An acute inflammatory response following radiosurgery with resultant acute venous thrombus formation and venous obstruction is proposed as one mechanism of an AVM hemorrhage in this patient. Radiographic evidence of the time course of thrombosis and hemorrhage supports the hypothesis that acute venous obstruction is a cause of intracranial hemorrhage.
Juanita M Celix; James G Douglas; David Haynor; Robert Goodkin
Related Documents :
23740494 - Extra- and intracerebral course of the recurrent artery of heubner.
16984954 - Haemodynamic changes after intracisternal papaverine instillation during intracranial a...
2680004 - Transcranial doppler studies in aneurysm patients.
24551604 - Anatomical variations of anterior communicating artery.
21801314 - Congenital right pulmonary artery agenesis with atrial septal defect and pulmonary hype...
8488444 - Severe subarachnoid hemorrhage during transsphenoidal surgery for pituitary adenoma.
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  111     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-07-02     Completed Date:  2009-08-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  124-31     Citation Subset:  AIM; IM    
Department of Neurological Surgery, University of Washington, Seattle, WA 98104-2499, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Acute Disease
Cerebral Angiography
Cerebral Hemorrhage / radiography*
Cerebral Veins / radiography
Fatal Outcome
Intracranial Arteriovenous Malformations / surgery*
Intracranial Thrombosis / radiography*
Middle Aged
Postoperative Complications / radiography*
Tomography, X-Ray Computed

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Discrete cerebral hypothermia in the management of traumatic brain injury: a randomized controlled t...
Next Document:  A novel pressure sensor with an optical system for coil embolization of intracranial aneurysms.